Provider Demographics
NPI:1376600569
Name:ROGERSON COMMUNITIES
Entity Type:Organization
Organization Name:ROGERSON COMMUNITIES
Other - Org Name:ROGERSON -EGLESTON ADULT DAY HEALTH PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL PERFORMANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:PICCARINI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:617-463-5836
Mailing Address - Street 1:2053R COLUMBUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119
Mailing Address - Country:US
Mailing Address - Phone:617-469-5800
Mailing Address - Fax:
Practice Address - Street 1:2053R COLUMBUS AVENUE
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119
Practice Address - Country:US
Practice Address - Phone:617-469-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
MA373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1905970Medicaid